Thursday, August 16, 2012
An article entitled "HIV prevention pill for heterosexuals at risk too" caught my eye because it reminded me of some email correspondence with people who worked in the US HIV/AIDS field in the 1980s. The short response is that most heterosexuals were not at risk, and most are still not at risk, especially where female to male transmission is involved. One of the correspondents even sent me the figures produced by the New York City Health Department.
These show that in 1991, less than 1% (8 people) of HIV positive men were thought to have been infected through sex with women at risk, compared to 55% who were thought to have been infected as a result of sex with men at risk and 35% as a result of intravenous drug use. In contrast, 25% of HIV positive women were thought to have been infected through sex with men at risk (and 85% of those women were either black or hispanic).
Later, the very low figures for HIV positive men infected by women were amended. As a result, the article above released just a few days ago can claim, though hardly justifiably, that "more than a quarter of new HIV cases each year are heterosexuals". Whereas in the earlier years of the pandemic, the NYC health department would follow up infections where the risk cited was heterosexual, they later ceased doing this. As a result, those claiming that they must have been infected through heterosexual sex were recorded as heterosexually infected.
One could speculate about why public health experts manipulated the figures to exaggerate the heterosexual risk. Perhaps they felt that the general public would have little or no sympathy for men who have sex with men or intravenous drug users? They may also have felt that there would be little sympathy for black and hispanic people, especially women. But now that HIV is such a big money earner for the pharmaceutical industry, the health department's manipulations are coming in very handy.
There has been a concerted effort to rapidly increase sales of antiretroviral drugs, to those who are HIV positive but don't yet need them, to those who only need them temporarily right now and even to those who are not HIV positive but are said to be 'at risk' by public health experts. In the first group, the majority of those newly infected, those who are most likely to transmit HIV, will not be identified early enough for treatment to be of much benefit; shortly thereafter, they will no longer be as likely to transmit the virus.
There's an interesting article in the English Guardian about Big Pharma creating opportunities to recategorize people as being in need of medication, whether they are sick or not. Mental health seems like the perfect field in rich countries. But HIV is a better one in developing countries, where the vast majority of HIV positive people live. And in developing countries with high HIV prevalence, HIV transmission among heterosexuals really is very high, in contrast to wealthy countries. The vast majority of HIV positive people in high prevalence countries are heterosexual and far more females than males are infected.
So in New York, a policy was adopted whereby it was accepted without further investigation if men said they must have been infected through heterosexual intercourse. In contrast, people in Africa who claim they have only had sex with their partner, or that they haven't had sex at all, tend to be disbelieved. Believing everything people say about their sex lives is a pretty stupid policy when there is scope to investigate further. But disbelieving everything people say about their sex lives when there is plenty of scope for investigating non-sexual risks sounds more like prejudice than anything else.
A better name for the prevailing HIV strategy, especially in developing countries, would be 'treat and treat'. Big Pharma honchos are falling over each other to mark out their new territories. The great thing about HIV gold is that you don't even need to bother finding it; you can just employ people to manufacture the stuff relatively cheaply. Evidence quite like the NYC health department's revised figures for heterosexual HIV transmission positively spurts out of research institutions, often to be amply rewarded by Big Pharma itself.
The best strategy right now would seem to be to test as many people as possible and treat those in need of treatment. We should adopt a test and investigate strategy. Because it is also vital to establish exactly how HIV is being transmitted in high prevalence countries, why those who should be least at risk, heterosexuals in long term relationships, are being infected in the highest numbers. This is a mystery for those who insist that 80% of HIV is transmitted heterosexually in high prevalence countries, a mystery that is in bad need of investigation.
The current HIV response may be (or may not be) appropriate for people who face high and identifiable risks, and who live in rich countries where healthcare is readily available to most. But it is entirely inappropriate where millions of people every year are being infected with a virus that is difficult to transmit heterosexually. The result of pretending that everyone is at risk of being infected with HIV is that many people who are infected have little idea of how they were infected and no idea of how to avoid infecting others. Now that various parties have made their fortunes and careers out of lying about HIV, isn't it time to go back to telling the truth? Don't worry, there's plenty of money still to be made, your work has ensured that.
[For more about non-sexual HIV transmission, see the Don't Get Stuck With HIV site.]